Morphine chloride; morphine sulphate (continuous); pethidine; pentazocine; fentanyl; tramadol; methadone; and codeine are all registered for use in Croatia. There is no immediate release morphine. Morphine consumption in Croatia is low at 0.7398 mg/capita3 in 1999 and had remained relatively stable for some years. Then in 2000 the Ministry of Health made an estimated morphine requirement for 12 kg of the drug; in 2002 the estimate had risen 313% to 50 kg. Opioid prescriptions are made out in duplicate; prescribing physicians keep a separate book of details of patients receiving opioid analgesics; prescriptions are valid for five days; the amount per prescription is limited, though the duration of treatment is not.4
INCB data on opioid consumption in Croatia between 1994 and 1998 are available for codeine, morphine, pethidine and cocaine. In that time codeine consumption almost doubled from 291 kg to 505 kg; morphine consumption increased over the same period only from 1 kg to 5 kg. Pethidine consumption fell during these years from 9 kg to 6 kg. Methadone consumption was relatively stable: 32 kg consumed in 1994, compared to 35 kg in 1998. A small amount of cocaine was consumed in 1995-97, 4 kg in total. The average daily consumption of defined daily doses of these drugs per million inhabitants between 1994-98 was: codeine (1883); morphine (32); methadone (527); pethidine (7).5
In February 2002, issues relating to the use of opioids in Croatia were summarised by an expert group6 as follows, and an action plan was formulated to address them:
Does national policy require the use of a special prescription form? Yes, duplicate for opioids.
Does the physician or institution have to pay for the special prescription form? No
Does national policy establish a validity period for opioid prescriptions? If so, what amount? Yes, 5 days
Does national policy establish a maximum amount that can be prescribed at one time? If so, what amount? Yes, 2 g morphine, 0.05 g fentanyl patch, 0.2 g methadone per prescription.
Does national policy limit the length of time that a patient may be treated with an opioid? No
Average defined daily doses of morphine, Central and Eastern Europe (1994-1998)
Source:Clark D, Wright M (2002)Transitions in End of Life Care: Hospice and Related Developments in Eastern Europe and Central Asia.Buckingham: Open University Press
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